The Obamacare exchange opens October 1, 2013 but will it be ready to roll?

Probably not . . .

That process is complex enough by itself. How much coverage do you want? What deductible? Are family members on the plan? Do you need an asthma program? Do you want to keep your current doctor? What about dental?

Kaiser Health NewsThat's getting ahead of yourself.Before selecting a plan, if you go through the exchange you need to know if you qualify for a subsidy. That is a 45 minute process.

Like other filtering software, Connecture’s program is a multi-step search engine, screening out inappropriate options (based on your input) to deliver a manageable menu. After getting past the basics (Stripped-down “bronze” plan or high-benefit “platinum”? High deductible or low?), the program asks if it’s important to keep your current doctor.

“Based on our research, the choice of doctor was probably the No. 1 and No. 2 [features] of what people are looking for in a plan,”

Good luck on that.

It may be almost impossible to find "your" doc on the exchange plans.

Need to see if your drugs are on the formulary?

Fat chance

To try to reduce sticker shock, Connecture shows your net premium price — after the tax credits are applied — early in the shopping process. But perhaps the most important feature is the one estimating the total cost of coverage, including deductibles and co-pays, based on your reported health status. Without that information somebody with a chronic condition requiring lots of care could choose a plan based only on a low premium, not realizing the total expense could be substantially reduced by paying a larger premium up front.

■ Unlike Aetna and UHC, Anthem will not be sending out rebate checks to Buckeye State insureds. Via email:

"On June 1, 2013, Anthem filed the required MLR report with Health and Human Services for the 2012 calendar year and met the required loss ratio for all lines of business for 2012. This means no notices will be sent and no rebates will be issued."

RIP Johnny Cash. Yes, he did spend time in prison but fortunately for him he had a trade to fall back on once he got out.Perhaps the same is true for today's felons.

Republican senators slammed the Patient Protection and Affordable Care Act’s navigator program Thursday arguing that the rule is so lenient that a convicted felon could qualify as a navigator and get access to consumers’ confidential health information.

“The standards proposed by your Department could result in a convicted felon receiving federal dollars and gaining access to confidential taxpayer information," the letter stated. "The same standards allow any individual who has registered with the exchange and completed two days of training to facilitate enrollment, as if the decision to purchase health insurance is similar to the decision of registering to vote."

The company's owner is a "devout Southern Baptist" whose religious beliefs [ed: remember when those were protected under the First Amendment? Good times, good times], prohibit abortifacients. Timing is everything, which seems to be working in Mr Beckwith's favor: since his "insurance plan was up for renewal this month, Beckwith could have been required to start covering the contraceptives while the case was under review. U.S. District Judge Elizabeth Kovachevich granted Beckwith a reprieve, saying the company may be due religious protections under federal law."

■ Via email, we learn that "[b]eginning in June and by August 1st, Aetna is scheduled to mail rebate notices and checks to policyholders and subscribers whose plans are due a rebate ... In this second year of MLR reporting, Aetna's rebates represent 0.2 percent of the premiums we collected"

That's down quite a bit from last year (the first for which MLR "rebates" were due), which the carrier interprets as indicating that they've met their pricing goal.

■ United Healthcare is also rolling out their 2013 MLR rebate initiative. Via email we learn that:

Wednesday, June 26, 2013

"A very interesting ACA development is taking place in Massachusetts today as the state that “inspired” Obamacare tries to reconcile its current law with the new federal law ... The amendment that was filed would force President Obama’s good friend Governor Deval Patrick (D), and his Administration, to seek a waiver from certain elements of Obamacare." [emphasis added]

And a friendly reminder to newbies and regulars alike
that, while it's not mandatory to give a link back, it’s the way that carnivals
work best. If your submitted post has been included in the Cav, please remember
to post about it on your blog because it helps us all.

The folks who are responsible for policing Obamacare are already celebrating on our dime.

Poor oversight by the Internal Revenue Service allowed workers to use agency credit cards to buy wine for an expensive luncheon, dorky swag for managers' meetings and, for one employee, romance novels and diet pills, an agency watchdog said Tuesday.

Two IRS credit cards were used to buy online pornography, though the employees said the cards were stolen. One of the workers reported five agency credit cards lost or stolen

Just when you thought it was safe, it seems the folks who gave us Obamacare have moved beyond jokes on late night TV and is now moving towards reality entertainment.The Obamacare question regarding subsidy eligibility seems innocuous enough.

The ACA requires Medicaid, CHIP and tax-subsidized exchange coverage to use Modified Adjusted Gross Income (MAGI) to determine eligibility for most individuals.

MAGI Training Materials for States - Check this Out!Louisiana - ever a font of creativity - has created this really ingenious and funny email training materials called MAGI Monday directed to eligibility workers. Using a "real life" case study of the Kardashians, the missives walk workers through how changes in household, income, and custody might impact how the eligibility determination is implemented and whether and who is eligible for Medicaid. The state is using this tool to help get their line staff acclimated to new concepts and rules before the in-depth trainings get underway. Susan Wright in Louisiana has kindly shared these so other states can use them or be inspired to create their own serials. We will be posting these weekly so you can keep current with all the twists and turns in the MAGI saga. Enjoy!

HHS is reaching out to the major sports leagues in hopes of partnering to promote the Patient Protection and Affordable Care Act. So far they have engaged with the NFL and the NBA.

For the NBA this partnership could have mixed outcomes. While it hits a significant part of their fan base, it is also a controversial law that could alienate the part of it's fan base who happen to be the drivers of the financial spend for tickets, concessions, and merchandise. For now.

More importantly it will impact their players. According to data listed on ESPN.com there are 534 players who received compensation during the 2012-2013 season. Of these, 492 earned more than $250,000. This is the magic number for paying the additional Medicare tax of 0.9% when filing as joint married. (I know some players are single but just bear with me)

Total salaries for all players over the threshold come to $2,021,287,266 which means that NBA players will be paying $17,086,835 in new Medicare taxes this year just on their salaries.

When PPACA flops will Joey Crawford be there to make the call? If so, what can the NBA fine HHS and President Obama for their efforts? If so, my guess is it won't come close to $17 million.

"Immigrants with provisional status may obtain insurance through employers, but many ... tend to work low-wage jobs at small businesses that don't have to provide the benefit under the [ObamaTax]."

And then one has to consider what happens when these larger employers figure out that they can hire these "provisionals" who are not subject to the [Evil] Mandate. How many American citizens will lose their jobs in favor of employees who aren't required to be covered?

Monday, June 24, 2013

It’s hard to understate the enormity of the task at hand for the Obama administration. It will be orchestrating the largest expansion of private health insurance in the country’s history. That means there’s a huge amount of work to be done over the next few months. There are at least 99 things that need to happen between now and October

Here they are:

1. Health and Human Services must certify that 17 states will be able to launch their own marketplaces. While these states currently have conditional approval, none have the final go ahead to launch their exchange.

2. Washington State must launch a health insurance exchange

3. Oregon must launch a health insurance exchange

4. California must launch a health insurance exchange

5. Idaho must launch a health insurance exchange

6. Hawaii must launch a health insurance exchange

7. Colorado must launch a health insurance exchange

8. Minnesota must launch a health insurance exchange

9. Kentucky must launch a health insurance exchange

10. Exchange list interruption: The federal government likely needs to work on the fact that 42 percent of Americans don’t know that the health-care law is a law at all.

The Los Angeles Unified School District will use a state grant to train teens to promote ObamaCare to family members. Covered California, the state's health insurance exchange, announced grants of $37 million on May 14 to promote the nationally unpopular law.

LAUSD will receive $990,000. The district listed as a primary outcome for its project, “Teens trained to be messengers to family members.”

Obamacare kicks off in 99 days. DC is still selling the health insurance plan that almost nobody wants.

The Department of Health and Human Services reportedly asked professional sports leagues to help them promote the law’s benefits. The leagues reach a wide audience, especially the young and healthy crowd the administration is trying to court so premiums on the exchange do not soar from an influx of older, sicker patients.

HHS Secretary Kathleen Sebelius said Monday the NFL has been “very actively and enthusiastically engaged” in the discussions, according to The Hill.

The government’s revamped website, healthcare.gov, features sleeker graphics than its prior iteration and features a “Start Now” button that guides users through the law’s benefits. There is a Spanish-language version of the site, at www.cuidadodesalud.gov, and the government’s call center will accommodate 150 languages through interpretation services, HHS said.

Ms Sheldon made the mistake of believing that the folks who run the Service actually care about the folks they ostensibly serve. This was, of course, a mistake:

"When Ms Sheldon tried to air her concerns that the CQC wasn’t up to the task of uncovering bad practice in hospitals and care homes, her messages to chief executive Cynthia Bower and other board members were not answered, or were stonewalled."

Remember, this is one of the platforms on which the ObamaTax is based, so it's a pretty significant peek into our own future. And it's not pretty:

"As a result, the CQC’s chairman, Dame Jo Williams, wrote to then Health Secretary Andrew Lansley asking him to sack her."

"The ensuing debacle was not just the result of a botched merger: it reflects an NHS culture which is profoundly, systemically and almost certainly irredeemably rotten." [emphasis added]

And it is, in fact, that culture which has been transplanted here. How else to explain the that Donald Berwick was, at one point, in charge of the agency in charge of implementing our train wreck?

And make no mistake, this culture is what leads to:

"[N]eglect and cruelty reached such a pitch that patients drank from flower vases to relieve their thirst ... these failings are not being addressed; because what rules in the NHS, from top to bottom, is a culture of ruthless unaccountability in which the buck stops nowhere."

Ah, that magic phrase: "culture of ruthless unaccountability." What does that remind us of?[Hat Tip: FoIB Holly R]

Why? More than 3 years after the legislation that no one read was signed into law, why is the government still trying to sell the public on the greatness of Obamacare?

Why? Almost a year after the Supreme Court ruled that Obamacare was a tax and the mandate was legal, why does DC still have to use non-sequestered taxpayer dollars to promote a plan that only a third of the nation supports?Why? If Obamacare is supposed to create a windfall in new revenue and profits to health insurance carriers, create more demand for prescription drugs and medical supplies, and minimize cash flow concerns of medical providers (especially hospitals), then why must we still be SOLD on how wonderful life will be?

The nonprofit group with ties to the president's team is poised to become the president's unofficial Obamacare marketing team, announcing this week that it will put its message in every corner of American life.

Its new campaign is called "Get Covered America," and the aim is to provide an easily understood set of reasons and directions to Americans who either don't have health insurance or have inadequate coverage to sign up.

"Get Covered America will engage you at your churches, schools and community events," said Enroll America President Anne Filipic in a YouTube video pitch announcing the plan.

Sunday, June 23, 2013

In 100 days the Obamacare health insurance exchanges will open for business . . . in a manner of speaking. In addition to shoppers hoping to stock up on sale prices for health insurance no doubt many will have questions.

Who will answer them?A company called Vangent.

The Department of Health and Human Services estimates that Vangent's call centers will receive 42 million calls about the federal marketplaces this year, a daily average of up to 200,000; plus answer 2,400 letters and 740 e-mails, and host 500 Web chats daily. Customer service representatives will take consumers through the process -- from shopping for a plan to enrolling.

KaiserNever heard of Vangent?They are the same folks that answer the phone at 1-800-MEDICARE.

"The number of calls they are likely to get will probably dwarf anything they saw in Medicare."Vangent declined requests for interviews.

Currently averaging 60,000 calls a day that is expected to spike to 200,000 daily.

No problem.

But these folks will be trained, right?

An HHS official said call-center representatives would "undergo extensive training" about the health law and basic insurance issues but could not provide more details.

Top secret.

Wonder if the NSA will be monitoring calls?

Employment ads for the call centers' "temporary customer service representatives" seek applicants who have a high school diploma or equivalent and six months of telemarketing or secretarial experience.

An HHS spokeswoman said that customer service representatives will answer questions by reading from HHS-approved scripts and provide state-specific information. However, she would not provide examples of the scripts or say whether they were tested with consumers.

Friday, June 21, 2013

By golly this minimum loss ratio thingy sure is working well, said every liberal journalist and health insurance company.

CMS released figures yesterday touting that the minimum loss ratio (MLR) requirements under the Patient Protection and Affordable Care Act saved consumers $500 million that must be paid back in the form of rebates. 8.5 million consumers will each receive a portion of the rebate checks which works out to an average of roughly $60 per person. This is down from $1.1 billion that was paid out last year. If hearing this news gives you the "warm and fuzzies" all over then you probably should stop reading here. For the brutal truth please continue.

This is how PPACA planned for MLR to work. Insurance companies must spend 80% of premium dollars they collect on medical claims. The other 20% goes towards operating costs and profit. If the percentage is less than the required amount then the insurance company must rebate customers the difference. If the percentage is higher then the insurance company simply loses out and has to cut their profit margin.

In 2011 the average single premium for health insurance was $5,222 according to the Kaiser Family Foundation. 80% of this figure, $4,178, must be spent on medical claims meaning the insurance company would retain $1,044. For 2012 this number increased to $5,616. 80% equals $4,492 which gives the insurance company $1,124. So, because of MLR, insurance companies were able to retain an additional $80 per insured person in 2012 versus 2011.

The latest figures available (2010 census) state that 195.9 million people are insured through the private market in the United States. Simple math: 195.9 million x $80 = the insurance industry was able to increase their bottom lines by $15,672,000,000!!!

So, why are we celebrating $60 being returned to 8.5 million people when 195.9 million people paid $80 more?

Only in Congress would this be kind of accounting be considered "savings".

Thursday, June 20, 2013

Life insurance, burial insurance, final expense policy. All terms for the same thing.

We come into this world with nothing and leave the same way. But most of us do leave behind unpaid bills.Credit cards, mortgage loans, car loans, bequests . . . the list goes on.But what happens if there is not enough money to take care of your funeral, much less outstanding debts?Apparently some folks go to great lengths to solve this problem.

A 59-year-old Apple Valley woman apparently buried her husband in her backyard because she was too poor to "give him a proper burial," authorities said Wednesday.

Patricia Hodges, 65, of Marietta in southeastern Ohio, was sent to a state prison for six months after law-enforcement officials found a pot-growing operation in her home in December 2011.

Investigators had been looking for Hodges’ mother, Janet Kelly. After they found the drugs, Hodges confessed that she had buried her mother in her backyard 14 years earlier and had been cashing her Social Security checks since then.

A Connecticut woman's fight to keep the remains of her deceased husband in her backyard has taken her all the way to the state Supreme Court, Fox Connecticut reports. Elise Piquet buried her husband, Doll, on her 8-acre property when he died in 2004 at the age of 84.

Piquet has said she made the plans for the private home burial because all the cemeteries in Chester, where the couple lived, were full.

We're pleased to announce that we've teamed up with eHealth to provide free, no obligation quotes for your Medicare Supplement insurance needs. Check out the shiny new widget in the sidebar to see how it works.

Um, Joe and Suzie? You can "change the definition" all you wish, but the reality is that employers will simply let employees go, and/or decline to hire new ones. And that means even more hardship for the very people you purport to want to help.

Under the Patient Protection and Affordable Care Act a new type of insurance issuer called a CO-OP must be created in every state. These CO-OPs are high-risk ventures: the Office of Budget and Management has projected a default rate for them as high as 43%. Through 2012 over $2 Billion had been distributed by HHS to these start up insurers. Last week Mike wrote an excellent post on one of them in New York which you can read here.This week the Buckeye state announced their list of insurers seeking to play in the CO-OP sandbox. The list included: Aetna (Individual only), AultCare, Community (Anthem), Coordinated Health Mutual, Coventry (Individual only), Kaiser Foundation Health Plan (Small Group only), Medical Health Insuring Corporation of OH (MMO), and Summa.

While there may be additional companies announced later, the one that really stands out is a company that may be unfamiliar to agents and consumers, new kid on the block, Coordinated Health Mutual. They are a CO-OP who received a federal grant for $129,225,604 in late 2012. Coordinated Health Plans of Ohio is sponsored by Community Health Solutions of America LLC, which also runs primary care medical homes for state Medicaid programs. Sounds innocent enough right? Lets connect some dots:According to filings, Brett Baby, CEO of Coordinated Health, and Community Health Solutions (CHS) of America LLC CEO, Dale F. Schmidt have troubled histories. Baby was the former CEO of Physicians Insurance Company of Ohio. They made it an entire year before going under when regulators shut them down for dropping $5 million in reserves. Schmidt has a longer history including chapter 11 bankruptcy filings in 2006 (including CHS), a 2011 Medicaid overpayment in South Carolina to his firm for $10 million, and back taxes owed in 2012 to the state of Kentucky.Brett and Dale are just the type of high quality financial gurus we want running an insurance company.What's most disturbing about the entire CO-OP process is that despite these risks and questionable backgrounds CMS refuses to answer questions about how recipients are chosen or any other information about the program. President Obama and Secretary Sebelius have asked for transparency in health care pricing. Evidently it's too much to ask of them to have transparency in health insurance regulation.

From California to Virginia, Texas to Michigan, local municipalities are coping with the drastic new regs in one of the few ways still available:

"We feel bad as a city administration and as a council in having to cut hours from 35 to 29," Medina [OH] Mayor Dennis Hanwell said. "We have the budget to pay the people, but we do not have the budget to pay for the health care." If they hadn't made that cut, the city faced up to $1 million in new health costs courtesy of ObamaCare."

For a city like Medina (just shy of 27,000 souls), that's a pretty hefty chunk of change. And when you start multiplying that by all the small towns across the fruited plain, you're talking serious coin. With U6 unemployment in the double digits, it's difficult for smaller cities to keep hitting their citizens with more and more taxes to cover public sector health insurance costs. Shrinking tax bases and increased insurance costs make for a powerful (and dangerous) combination, as we're seeing now.

Tuesday, June 18, 2013

By now, most folks know that Sarah Murnaghan got her new lungs, and for that we say "Baruch HaShem" (Praised be G-d). As life is the most precious of gifts, one can't help but be moved by her new-found hope and lease on life.

In Judaism, we are encouraged to consider all facets of a given subject or issue. That is, our job is to find "balance," and so even happy occasions require us to consider the not-so-happy alternatives (eg breaking of the glass at a wedding). And there are plenty of negative aspects to this story, as well.

Let's start with the most obvious: as we noted in our original post on the subject, how do the transplant folks say "no" to the next little boy or girl who wants a shot at adult organs? Has the process, which seemed to be working well and fairly up to now, been irretrievably broken?

I think there's a very strong case to be made that the answer is "yes:" from this point forth, it will be the lawyers, judges and media making life-or-death decisions. Two old saws seem to have been proven right here: "once is always" and "the squeaky wheel gets the grease." That is, the precedent has now been set that the ones with the most photogenic donee and the most money and the best "story" are going to be getting free passes to the front of the queue, leaving those with fewer such resources in the dust, regardless of actual need or physical condition.

And that brings us to the next question: what mother or father, or sister or brother, was just condemned to death so that little Sarah might live? And don't be fooled: this is exactly the outcome here. Someone else on the list, presumably much higher on it, in fact, was passed over for that set of lungs, and there's no guarantee that another suitable set will be available in time.

Now, the organization which oversees transplants has added a codicil "that allows for occasional exceptions. These children have to be recommended by their doctors and then have their cases reviewed by a national board before they can actually be exempted;" which is all well and good, until one notices that the criteria seem to be rather self-fulfilling.

And, finally, there's this: the case of Ms Sarah actually serves to underscore that which another (older) Sarah noted with the passage of the ObamaTax: Death Panels. And make no mistake, that is precisely what happened here: a government employee - who, by the way, is not a doctor and apparently has zero medical training - just condemned to death an adult who was not as cute and cuddly as Sarah Murnaghan, and whose family did not have the means and the media to plead their case (if they even knew about it in the first place).

"In the matter of reforming things, as distinct from deforming them, there is one plain and simple principle; a principle which will probably be called a paradox. There exists in such a case a certain institution or law; let us say, for the sake of simplicity, a fence or gate erected across a road. The more modern type of reformer goes gaily up to it and says, “I don’t see the use of this; let us clear it away.” To which the more intelligent type of reformer will do well to answer: “If you don’t see the use of it, I certainly won’t let you clear it away. Go away and think. Then, when you can come back and tell me that you do see the use of it, I may allow you to destroy it.”

The concept seems pretty straightforward: you take an older life insurance policy and sell it ("viaticate" is the technical term), and then use the proceeds to pay for long term care. When the policy's value is used up, one turns to Medicaid for continued long term care funding.

This is not a new idea, but the fact that states are now touting it as a viable LTC funding vehicle is telling: they're running out of money and are desperately looking for ways to slow down the ticking time bomb. Under current Medicaid rules, one is allowed to have some life insurance, but of course, that's an asset that states would very much like to tap.

Another factor is marketability. If there's a sudden glut of life insurance policies hitting the market, then of course the price that they command will be affected. Add in the fact that the key phrase in LTC is longterm and potential investors could be waiting many, many years for a payoff. Not a great selling point.

But what I find so disgusting here is the states' apparent disregard for their own previous condemnation of stranger-owned life insurance. If it's morally reprehensible in one circumstance, why is it suddenly noble in this application?

Monday, June 17, 2013

The federal government under Obamacare will be exposing your private parts. Most of the consumer protection that was put in place under the Clinton administration now goes away under Obama.

A new rule issued late Friday requires state, federal and local agencies as well as health insurers to swap the protected personal health information of anybody seeking to join the new health care program that will be enforced by the Internal Revenue Service.

Personal health information, or PHI, is highly protected under federal law, but the latest ruling from the Department of Health and Human Services allows agencies to trade the information to verify that Obamacare applicants are getting the minimum amount of health insurance coverage they need from the health "exchanges."

Sunday, June 16, 2013

Both the Wall Street Journal and Reuters reported Friday that Aetna will exit the California individual-insurance market at the end of 2013.

According to Aetna, this decision "will affect only 49,000 of its 1.5 million policyholders in the state."

Although Aetna declined to say why it is taking this action, it's likely that the reason is California's health exchange rules. According to Reuters the California Exchange rules apply to all health insurance products sold to
individuals in the state, "whether or not they are offered through the
exchange."

Thus any company that decides after analysis that it's not worth the cost for it to participate in the California Exchange, can only avoid that cost by exiting the market - as Aetna has decided to do.

Saturday, June 15, 2013

To study the likely costs of plans on the Georgia insurance exchange, the AJC selected one proposed plan from the gold, silver and bronze tiers offered by Blue Cross and Blue Shield of Georgia. (Seven companies applied to sell insurance on the Georgia insurance exchange, but these examples are limited to selected plans

on Blue Cross’ filing.) Note that insurers may offer more than one plan within each “metal tier” with co-payments and deductibles that will vary. Here is the cost-sharing information related to the selected plans:

Gold plan: $750 deductible, 0 percent coinsurance

Silver plan: $2,000 deductible, 20 percent coinsurance

Bronze plan: $6,300 deductible, 0 percent coinsurance

The prices, which are premiums per month, assume that the consumer lives in metro Atlanta and is a nonsmoker.